Thursday, November 06, 2008

That is what a friend of mine said to me last month as he articulated his frustration with increasing premiums and declining service. I’m not so sure about the “gold standard” thing but I will say that it seems like my recent dealings with big blue have been more frustrating than they used to be.

Then again, I didn’t used to think much about health insurance. For me it was just like automobile insurance or homeowners insurance. I was happy just to have it and I hoped I’d never really need it.

Sadly that is no longer the case. As I have gotten older heath insurance has become more important because that is what drives the quality of health care I receive and that care begins with my primary care physician.

My previous primary care doc was a good guy. His office, on the other hand, was a nightmare. It was common to sit in his waiting room for at least half and hour after arriving for a scheduled appointment. When I’d finally be ushered into an exam room I’d typically wait another twenty minutes before actually seeing him. I’d then get about ten minutes of quality time. In return for this privilege I paid my big blue insurance company over $300 per month.

I put up with this situation until it literally became unhealthy. A little over a year ago I came home from my morning run and was feeling pretty beat up. At Mama Wordbones insistence I scheduled an appointment with my doc for later that week. When he finally entered the exam room for our “quality time” I told him that my chest felt tight and I was feeling generally lethargic.

“Stop running and see me again in a week.”

Three days later I had a heart attack. I never saw him again. After some research I found a new primary care doc.

Now my doc has decided to move his practice to a non insurance model. He will no longer deal with big blue or any other insurance company for that matter. He does not believe that the insurance reimbursement model allows him to deliver quality care to his patients. If I want to continue seeing him I will need to pay him directly. I have decided that this makes perfect sense for me.

5
comments:

Freemarket
said...

I read your column in the BM yesterday and I thought that it missed the real issue.

Your beef should not be with the insurance companies, but rather with the buffoons you voted into office. The supply of doctors is severely limited by the government and by medical labor unions. This is done under the guise of benefiting patients. However, the effect of this well meaning regulation is to create a low supply of high quality doctors, who are swamped in a high volume of customers. This also drives up the price of medical services such that you are a fool to visit the doctor without insurance to pay for your visit.

The simple fact is that people should be free to choose who treats them for illness. If they feel that someone with the professional expertise of a nurse or a physician’s assistant would be a better cost/benefit trade off that seeing a full fledged doctor, they should free to make that decision. If I have a case of poison ivy, I don’t think that I should have to waste a doctor’s time when a nurse could diagnose and treat is just as well for a fraction of the cost. My simple-ass elected officals disagree.

My own nightmare story included a visit to the Ellicott City doctor whose staff left me in the waiting room for HOURS. I was so ill and dehydrated that I had to leave for a drink, and come back to the office to wait longer. The kicker? I got the horrid sickness from being in his waiting room for too long for an appt. in the prior week.

I selected this physician after another had left me in his waiting room for an hour and 45 minutes. Also, his staff left one day after a flake of snow and didn't notify any patients! We all showed up to locked doors and no lights. The pediatrician downstairs told us that patients had stopped by for hours asking about it.

WBMaryland does have a deficiency of doctors and nurses for several reasons I'm sure. The cost of malpractice insurance is exorbitant. The overwhelming majority of lawyers in Annapolis refuse to move malpractice litigation to a process of arbitration. I wonder why.The HMO contracts offered by the few remaining insurance companies have the fees deeply discounted. No wonder docs are leaving the state or setting up these new fee based boutiques which refuse to accept insurance. The boutiques make a whole lot of sense to the docs because having 400 patients at $1500 each is $600,000 vs having 2000 patients and earning $150,000. Plus you don't have to worry about being undercompensating or paid at all by the insurer. There is a Blue Cross product that fits well with the new boutiques and that is the high deductible Blue Preferred plan. This plan is a PPO plan that doesn't require a primary care physician. You can continue going to your newly boutiqued doctor and Blue Cross won't object. So what if it costs more than an HMO OA high deductible plan. You'll be forever thankful when you have a heart attack, brain aneurism, kidney transplant or other life threatening emergency.HH

As self-employed business owners, we've dropped all of our insurance and pay cash. What freedom! It feels great to not have to pay the insurance premiums each month. And if something big happens? Oh well, we'll make some sort of payment arrangement with the hospital, and settle for, say, $100/month for the rest of our lives. Still less than insurance...

Of course, our politicans continue to spread FUD in telling us that the world will come to an end if there is no insurance (and don't think the MD community is entirely innocent here, too). Gee, ever wonder WHY medical costs are what they are? It's because of insurance! Ban insurance, and watch these artifically-inflated costs come down out of the stratosphere.

That's certainly one alternative.I guess you can still say you get what you pay for.Blame the insurance companies for higher rates than you're willing to pay, but also blame the lawyers, and the politicians, and the pharmaceutical companies, and ...oh yes, the uninsured who have the money and are willing to use the emergency rooms and throw their cost back on the hospitals and insurance companies who have to charge the insured for their uninsured care.Healthcare costs are like any other expenses we pay.If you ride a bike to work, it might cost $150. If you go any distance, you need a car or a train or bus and the annual cost is substantially more. Ask anyone who is ill with a debilitating heart condition, diabetes, or other pernicious illness whether they want to drop their insurance or not and they will tell you they couldn't survive without it. Who in the world wants to spend the rest of their lives paying off a hospital bill, being dogged by collection attorneys, and losing what savings they have accrued over their lifetime due to a catastrophic uninsured medical condition. I just think your venting...which is ok too.HH

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